Large V waves in the pulmonary wedge pressure tracing in the absence of mitral regurgitation.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
H Smith
Publications and source records attributed to H Smith.
Infection and diabetes: the case for glucose control.
This review summarizes data concerning the host resistance to infection in diabetes and the influence of an acute infection upon the endocrinologic-metabolite status of the diabetic patient. While it is well known that acute infections lead to difficulty in controlling blood sugar levels and the infection is the most frequently documented cause of ketoacidosis, controversy persists as to whether or not patients with diabetes mellitus are more susceptible to infection than age- and sex-matched nondiabetic control subjects. Our data obtained from the charts of 241 diabetic patients who were being followed as outpatients show a striking direct correlation between the overall prevalence of infection (p less than 0.001) and the mean plasma glucose levels (representing three or more fasting glucose determinations taken at times when no evidence of infection existed). There is a significant diminution in intracellular bactericidal activity of leukocytes with Staphylococcus aureus and Escherichia coli in subjects with poorly controlled diabetes in comparison with the control group. Serum opsonic activity for both Staph. Aureus and E. coli were significantly lower than in the control subjects. Taken together, the results from published reports as well as our data suggest to us that good control of blood sugar in diabetic patients is a desirable goal in the prevention of certain infections (Candida vaginitis, for example) and to ensure maintenance of normal host defense mechanisms that determine resistance and response to infection.
Antibody Formation↗
Randomized versus historical controls for clinical trials.
To compare the use of randomized controls (RCTs) and historical controls (HCTs) for clinical trials, we searched the literature for therapies studied by both methods. We found six therapies for which 50 RCTs and 56 HCTs were reported. Forty-four of 56 HCTs (79 percent) found the therapy better than the control regimen, but only 10 of 50 RCTs (20 percent) agreed. For each therapy, the treated patients in RCTs and HCTs of the same therapy was largely due to differences in outcome for the control groups, with HCT control patients generally doing worse than the RCT control groups. Adjustment of the outcomes of the HCTs for prognostic factors, when possible, did not appreciably change the results. The data suggest that biases in patient selection may irretrievably weight the outcome of HCts in favor of new therapies. RCTs may miss clinically important benefits because of inadequate attention to sample size. The predictive value of each might be improved by reconsidering the use of p less than 0.05 as the significance level for all types of clinical trials, and by the use of confidence intervals around estimates of treatment effects.
Abortion, Habitual↗
A ? developmental characteristic of the ultrastructure of childhood leukaemic lymphoblasts.
Areas of chromatin demarcated from the rest of the nucleus ("separations") were found frequently in acute lymphoblastic leukaemias of childhood, in some patients in apparently all leukaemic cells, but rarely in non-lymphocytic leukaemias. In normal lymphocytes, separations were most common in fetal thymus, and less frequent in fetal lymph node and bone marrow, and child thymus, lymph node and marrow. Separations may be a developmental marker, and fetal lymphoid tissues, especially thymus, may have significance in the origin of lymphoblastic leukaemias of childhood. Nuclear loops enclosing cytoplasmic material were associated with, and may have similar significance to, separations.
Bone Marrow Cells↗
Relationship between QRS width and the presence of neoplasm.
This study examines the relationship between QRS width and the presence of neoplasia. The QRS width was measured in 236 consecutive ambulatory patients. The patients' body surface area, CBC, SMA 6, and SMA 12 were also recorded. There were 17 out of 34 (50%) patients with neoplasia in the group with QRS less than 0.08 seconds. There were only 19 out of 78 (24%) with neoplasia in the group with QRS greater than or equal to 0.08 seconds (P less than 0.01). We conclude that there is a higher incidence of neoplasia in patients with a QRS less than 0.08 seconds than in patients with a QRS greater than or equal to 0.08 seconds. This difference cannot be explained by age, body surface area, hemoglobin, or any variable in SMA 6 or SMA 12.
Aged↗
Hepatitis A and B at the London Zoo.
Explore the source record for details and available documents.
Animals↗
Urine pH and phencyclidine excretion.
Subeffective doses (0.5 mg) of 3H-phencyclidine (PCP) were given intravenously to three healthy men under two regimens designed to alkalinize or acidify their urine (oral sodium bicarbonate or ammonium chloride). The concentrations of PCP and its metabolites in saliva, plasma, and urine for 7 hr after injection were determined by high-performance liquid radiochromatography. A sample of perspiration from one subject was analyzed. The effects of physical exercise on the plasma concentration and urinary excretion of PCP were also studied. Multiple linear regression analysis showed the logarithm of renal clearance the renal clearance of PCP. PCP and its metabolites are also excreted in perspiration. Our results support clinical reports of the importance of vigorous acidification of urine and diuresis in treatment of PCP intoxication.
Adult↗
The behaviour of uranium-233 oxide and uranyl-233 nitrate in rats.
233UO2 and 233UO2(NO3)2 in aqueous suspension have been administered to rats by pulmonary intubation. The 233U associated with the fraction of the 233UO2 less than 4 nm in diameter translocates from lungs to blood at the same rapid rate as 233U from 233UO2(NO3)2. Identical reactions with blood plasma and lung fluid were observed whether the 233U was administered as less than 4 nm 233UO2 particles or 233UO2(NO3)2. It is suggested that oxidation of UO2 to UO3 occurs followed by the formation of uranyl ion. In blood plasma, approximately 50 per cent of the 233U is bound to transferrin, 25 per cent to citrate and 25 per cent on bicarbonate.
Animals↗
Differential retention of 212Pb ions and insoluble particles in nasal mucosa of the rat.
The time course of retention of 212Pb ions in ciliated nasal epithelium and of tagged insoluble particles, which served both as a deposition vector and marker for mucus, was measured in 13 rats by counting the head externally at 2 min intervals up to 100 min after deposition. On average, 70-75% of insoluble particles introduced onto ciliated epithelium in 3 microliters of distilled water were cleared to the gut with a half-time of approximately 15 min (range 6-35 min). A smaller fraction of lead ions (averaging about 60%) introduced in the same water sample was cleared to the gut with a half-time in each rat similar to that of particle clearance. Rapid uptake of about 8% of deposited 212Pb into blood was also observed. A compartment model consistent with the observed nasal retention and appearance of 212Pb in blood showed that, on average, 8% of deposited lead ions were transferred to the blood with a half-time of 15 min. For about 35% of the deposited lead ions and 25% of the particles, no clearance was detected up to 60-100 min after deposition. It is probable that a fraction of the lead ions are retained by epithelial tissue.
Absorption↗
Elevation of nasal viral levels by suppression of fever in ferrets infected with influenza viruses of differing virulence.
The effect of suppression of fever on viral levels in nasal washes of ferrets infected with either of two clones (7a, virulent; 64d, attenuated) of the recombinant influenza virus A/Puerto Rico/8/34-A/England/939/69 (H3N2) was studied. The febrile response was reduced by shaving the ferrets or by treating them with sodium salicylate, which had no noticeable effect on the inflammatory response. For both clones, significantly more virus was shed in the nasal washes of ferrets whose febrile response was suppressed, and the viral levels decreased less rapidly than in untreated ferrets or in those in which the treatments were ineffective.
Animals↗
Genetic composition and virulence of influenza virus: differences in facets of virulence in ferrets between two pairs of recombinants with RNA segments of the same parental origin.
Facets of virulence for ferrets of 16 recombinant clones of two parent viruses A/Finland/4/74 (H3N2) and A/Okuda/57 (H2N2) were determined and viewed in relation to their genetic composition. Of the five pairs of recombinant clones with RNA segments of the same parental origin, differences in facets of virulence were detected between members of two of the pairs. One pair differed in ability to produce fever, and another pair in ability to infect the lower respiratory tract. Subsequent analyses indicated slight differences in two genes of the first pair of viruses. Of all the recombinant clones examined the three that derived their surface antigens from the attenuated parent (A/Okuda) were less virulent than the 13 which possessed the surface antigens of the virulent parent (A/Finland). The virulence of the latter clones tended to decrease as the number of RNA segments that were derived from A/Okuda increased.
Animals↗
Outer membrane proteins of Neisseria gonorrhoeae associated with survival within human polymorphonuclear phagocytes.
The determinant(s) of gonococcal resistance to killing by human polymorphonuclear (PMN) phagocytes appear to be present in outer membrane vesicles (OMV) purified from lithium chloride extracts of Neisseria gonorrhoeae strain BS4 (agar) by wheat germ agglutinin (WGA) affinity chromatography. OMV neutralized the ability of antisera raised against whole gonococci to drastically reduce the capacity of strain BS4 (agar) to survive within PMN phagocytes. Furthermore, analysis by SDS-PAGE of OMV/WGA precipitates from lithium chloride extracts of strain BS4 (agar) and strain BSSH, which was more susceptible to phagocyte killing than strain BS4 (agar) and yielded OMV with poor antiserum-neutralizing activity, suggested that three proteins were associated with resistance to phagocyte killing.
Bacterial Outer Membrane Proteins↗
Purification of pili and outer membrane vesicles of Neisseria gonorrhoeae by wheat germ agglutinin affinity chromatography.
Previous studies indicated that OMVs of Neisseria gonorrhoeae reacted specifically with WGA. A technique was therefore developed for the separation of gonococcal pili and OMVs by WGA affinity chromatography. This method was more convenient and more effective than isopycnic centrifugation for obtaining OMVs free of pili. The antigens were further purified but though homogeneous as judged by in vitro analytical methods, they both elicited an antibody response in animals to minor impurities previously undetected.
Antigens, Bacterial↗
Detection of antibodies to influenza virus M protein by an enzyme-linked immunosorbent assay.
An enzyme-linked immunosorbent assay test system was developed in which purified influenza virus M protein was used for the detection of M antibody in human sera. Antibody levels to influenza A virus M protein were monitored in sera from a vaccine study population by using an enzyme-linked immunosorbent assay technique with purified M protein as the adsorbent antigen. A 10-fold variation in titers of preexisting M antibody was observed in this population of young adults. Increases of anti-M titer of 7- to 24-fold were observed upon immunization with Formalin-inactivated vaccine or after natural infection. The antibody response to M protein was dissociated from the response to the hemagglutinin or neuraminidase antigens. The M antibody response preceded or was coincident with the antibody response to H1 hemagglutinin upon natural exposure to circulating virus.
Antibodies, Viral↗
Induction of phenotypically determined resistance of neisseria gonorrhoeae to human serum by sera from patients with gonorrhoea.
Some human sera contain factors which induce in gonococci a resistance to killing by fresh human sera. Individuals with serum containing these factors might possibly be more prone to gonorrhoea. A survey of the sera of 50 female and 50 male patients with gonorrhoea for resistance-inducing capacity showed, however, that the proportions of positive sera (24% for women, 28% for men) were not significantly different from those (16% for women, 24% for men) from an equal number of controls. Examination of the results, however, in relation to the type of gonococcal infection showed that: (a) the sera of 15 female patients with complicated (salpingitis) or successive infection or both did not induce resistance (statistically significant); (b) a greater proportion (34%) of sera from female patients with single gonococcal infections induced higher gonococcal resistance than for control sera (16%) (at the borderline of statistical significance); and (c) a greater proportion (38%) of sera from the few male patients with successive infections induced higher resistance than for control sera (24%) (not statistically significant).
Animals↗
Induction in gonococci of phenotypic resistance to killing by human serum by human genital secretions.
Cervical secretions and seminal plasmas from uninfected clinically healthy persons and vaginal exudates from patients with infections other than gonorrhoea converted gonococci susceptible to killing by fresh human serum to resistance after three hours' incubation at 37 degrees C. The inducing factors present in the genital secretions explain the serum resistance of gonococci from patients with acute urethritis. This serum resistance is lost on subculture in laboratory media but could play an important role in vivo in the survival of gonococci in the initial stages of urogenital infection when serum factors are liberated into the local infection site during inflammation.
Blood Bactericidal Activity↗
Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man.
The administration of verapamil to patients receiving beta-adrenergic blocking drugs is reported to produce adverse circulatory reactions, but a systematic investigation of this potential drug interaction has not been performed in man. We administered 40-, 80- and 120-mg doses of verapamil orally to 15 patients with angina pectoris who were receiving high doses of propranolol or metoprolol. Verapamil produced dose-dependent decreases in cardiac performance: with 120 mg, cardiac index decreased by 0.38 l/min/m2, stroke volume index decreased by 2.8 ml/beat/m2 and heart rate decreased by 6 beats/min, associated with increases in pulmonary capillary wedge (2.2 mm Hg) and mean right atrial pressures (1.7 mm Hg) (all p less than 0.01); two patients had marked, but asymptomatic, hypotensive reactions. In contrast, repeat administration of 120-mg doses of verapamil 24--30 hours after withdrawal of beta blockade produced no significant cardiodepressant effects despite significantly higher plasma levels of verapamil than during propranolol therapy (383.1 vs 205.1 ng/ml, p less than 0.01). In conclusion, verapamil produces significant negative inotropic and chronotropic effects in patients treated with beta-adrenergic antagonists; combination therapy should therefore be used with caution in patients with angina pectoris.
Adult↗
Psychiatric records: variations based on discipline and patient characteristics, with implications for quality of care.
In this study of the delivery of outpatient psychiatric care to Medicaid patients at all 29 free-standing psychiatric clinics and at six hospital clinics in New York City, the authors found that nonphysician mental health workers provided much direct patient care: diagnosis and identifying data, necessary for reimbursement, were always included in records whereas mental status and medical history were poorly documented; and nonphysicians in hospitals generally surpassed physicians in the latter two areas. An additional observation was that attitudes of mental health workers toward certain diagnostic and ethnic groups may be inferred from the selective completeness of their psychiatric record keeping.
Attitude of Health Personnel↗